The Fight to Beat Childhood Cancer

An incredible amount of people still believe that cancer is an “old person’s” disease, or at least an “adult” disease and are shocked when they find out that this is not so.

This is especially true in Africa, especially in the rural areas where information that we take for granted since the advent of the worldwide web and Google is not available, and old beliefs and cultures rule.

This belief is also true partly because, 99% of the time, cancer IS a malady tied to age. The cells in our bodies sometimes lose their battle against the toxins we’re exposed to, the sedentary lifestyles we lead, the viruses we contract as we go about our adult lives, and our genetic predispositions, and proliferate uncontrollably.

The approximately 1% of remaining cancers occur in children. It’s a particularly cruel reality when infants, toddlers, and teenagers draw the proverbial short straw despite their comparatively unpolluted anatomies.

We are, however, more hopeful when it comes to children’s cancer, because young bodies tolerate aggressive chemotherapy far better than older ones, and survival rates among children are higher in most of the world.

Some of the reasons for this hope are:

Children Get Different Types Of Cancer Than Adults

Two of the more common paediatric cancers start with B’s: cancers of the Blood and Brain. Paediatric tumours also develop in the bones, the kidneys, the liver, the nervous system, the connective tissue between organs, and the lymphatic system.

The relative upside to some of the big, bad B’s and their evil cohorts is that many of the treatments for these paediatric-specific cancers have produced spectacularly successful results:

• Children with cancers of the brain and nervous system have a 73% survival rate of five years or longer.

• 88% of children with both Hodgkin’s disease and non-Hodgkin’s lymphoma survive for at least five years after diagnosis.

• Most critically, Acute Lymphoblastic Leukaemia (ALL), a blood disease that represents the most common type of leukaemia in children, responds well to both chemotherapy and newer immunotherapy drugs, and around 90% of patients are still in remission after 10 years.

 

Children Tolerate Chemotherapy Better

The list of side effects from chemo and other drugs that can kill rapidly dividing cells includes nausea, heartburn, indigestion, upset stomach, diarrhoea, mouth sores and more, but children can usually tolerate more chemotherapy before they become ill.

Children rebound from the lifesaving toxins more quickly than adults because they don’t tend to have additional health issues—like lung or kidney problems—and their developing bodies adapt well to novel stimuli.

 

More is Being Done to Save Limbs

The field of comparative oncology — the study of cancer in people and pets to benefit both species — often turns to dogs because they share more than 80% of human genes.

Dr. Nicole Ehrhart, professor of surgical oncology at Colorado State University’s Flint Animal Cancer Center, who does clinical trials that are similar to those for human cancer patients, is currently focused on trying to improve reconstruction techniques after surgeons remove bones and muscle tumours from legs and arms.

“When you mechanically replace a portion of a leg bone, that bone doesn’t grow [anymore],” Ehrhart says. “Adolescents end up needing to undergo 15 to 30 surgeries in a lifetime because their devices experience wear, mechanical failure, and infection.”

Ehrhart is currently leading a research study that’s looking at whether stem cells culled from fat, bone marrow, or muscle tissue can regenerate bones and muscles for dogs with any cancer that affects those parts of the body. If her work is successful, she hopes it will lay the groundwork for research in humans—potentially saving the paediatric cancer field years of time it can devote, instead, to keeping children alive.

The Pawprints pet therapy program matched Carter with Ollie as he recovered from surgery. After removing the cancerous tumor in Carter’s leg bone, surgeons performed a rotationplasty, attaching his lower leg (rotated 180 degrees) to his thigh bone. The ankle was used as a new knee joint, to which Carter can attach a prosthetic lower leg.

Katherine Janeway, MD, a paediatric oncologist at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, and veterinary oncologist Cheryl London, DVM, PhD, of Tufts Medical Center and Cummings School of Veterinary Medicine at Tufts University, are comparing the genetic abnormalities in tumour samples from dogs and human patients.

As they uncover common pathways, they plan to develop clinical trials of immunotherapy, using novel agents that stimulate the immune system to try to kill cancer cells in dogs.

After analysing the results, the most promising approaches will be moved into clinical trials for children.

With well over 10,000 dogs diagnosed with osteosarcoma every year, compared with 1,000 children and youth, there’s an opportunity to glean information from canine trials relatively quickly.

“For designing clinical trials for osteosarcoma,” Janeway says, “the data from dogs is incredibly valuable.”

In March 2016, Ollie, a therapy dog at Boston Children’s Hospital, paid a bedside visit to 7-year-old Carter Mock. The pug and the boy had something in common: Both had lost limbs to the bone cancer osteosarcoma. Ollie’s left front leg had been amputated at the shoulder, while Carter had just had a new knee fashioned from his ankle in a procedure called rotationplasty.

 

All Paediatric Brain Tumours (except one) are Curable

Diffuse Intrinsic Pontine Glioma (DIPG) is a very complex tumour wherein cancerous cells grow among normal cells “like salt mixed in with sand,” and make themselves at home in the brain stem, which controls breathing and swallowing. This means surgery is not an option.

DIPGs have proved invulnerable to medication too. And while radiation can shrink the cells, they never go away. Life expectancy from diagnosis is less than a year.

Research into curing DIPG is ongoing and Children’s Hospital Colorado’s Dr. Adam Green and his colleagues believe they have isolated the mutated gene that drives the growth of DIPG.

Green and Co. are trying to understand how that gene causes changes in cells and which medications—either brand-new or already-approved pharmaceuticals—might be able to target those problematic shifts.

 

Many New Immunotherapy Drugs are being Developed for Paediatric Cancers

Typically, the immune system recognises damaged cells as a serious threat and tries to get rid of them. But it’s difficult for the immune system to recognise paediatric cancer cells because they often don’t look all that different from normal cells. Fortunately, ALL cells can be distinguished by specific proteins that hang off the surface.

Dr. Terry Fry and his colleagues modified T lymphocytes, a type of white blood cell crucial to immune function, into super soldier T cells, aka CAR-T cells, designed to locate and kill ALL cells that express these proteins. To date, 70% to 90% of patients across multiple early clinical trials went into complete remission.

CAR T-Cell Therapy was approved in August 2017 ~ the first time that the Food and Drug Administration (FDA) approved CAR T-cell therapy for a form of cancer ~ for the treatment of paediatric and young adult patients with B-cell ALL that has relapsed or hasn’t responded to previous treatments.

Unfortunately this treatment is exorbitantly expensive and out of the reach of many families who have a child with cancer, and is also not available in many countries such as South Africa.

At today’s exchange rate, the $547,000 price tag equals a WHOPPING R7,467,511.37  (that is 7.5 MILLION RAND!!!) WHO can afford THAT??